Ultrasonic treatment apparatus and ultrasonic treatment assembly

ABSTRACT

A ultrasonic treatment apparatus includes a handpiece. The handpiece includes a probe and a hollow sheath. The sheath covers and protects the probe. The probe has a rod-shaped main body portion and a treatment portion provided at the distal end of the main body portion. The treatment part includes a cutting region. The sheath includes a first portion covering the main body portion and a second portion covering the curved portion of the treatment portion. The physician inserts the probe and sheath into the joint space and strikes the cutting area against the bone. When ultrasonic vibration is transmitted to the probe, the bone is cut.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation Application of PCT Application No.PCT/JP2015/083591, filed Nov. 30, 2015 and based upon and claiming thebenefit of priority from prior US Provisional Patent Application No.62/196158, filed Jul. 23, 2015, the entire contents of all of which areincorporated herein by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates generally to an ultrasonic treatmentapparatus and an ultrasonic treatment assembly.

2. Description of the Related Art

International Publication No. 2010/087060 discloses a treatment systemfor surgery having an arthroscopic apparatus and a treatment apparatusfor surgery. In the treatment system for surgery, a doctor inserts anarthroscope of the arthroscopic apparatus and a treatment tool of thetreatment apparatus into a joint cavity, and performs treatment by usingthe treatment tool under arthroscopy in the joint cavity.

BRIEF SUMMARY OF THE INVENTION

In order to accomplish the object, in an aspect of he present invention,an ultrasonic treatment apparatus used for arthroscopic surgery includesa probe which includes a main body section to which ultrasonic vibrationis transmitted, and a treatment section provided in a distal end side ofthe main body section and having an excision region which excises a boneby the ultrasonic vibration; and a sheath which includes a first portionprovided to cover the main body section of the probe, and a secondportion extending from the first portion that covers a part of thetreatment section closer to a proximal end side than the excisionregion.

Advantages of the invention will be set forth in the description whichfollows, and in part will be obvious from the description, or may belearned by practice of the invention. Advantages of the invention may berealized and obtained by means of the instrumentalities and combinationsparticularly pointed out hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention, andtogether with the general description given above and the detaileddescription of the embodiments given below, serve to explain theprinciples of the invention.

FIG. 1 is a schematic diagram of a treatment system according to thefirst embodiment of the present invention.

FIG. 2 is a side view of a handpiece of an ultrasonic treatmentapparatus of the treatment system shown in FIG. 1.

FIG. 3 is a cross-sectional view of the handpiece taken along a plane ina longitudinal axis C of FIG. 2.

FIG. 4 is a cross-sectional view of an enlarged portion A of FIG. 3.

FIG. 5 is a side view illustrating a positional relationship between theultrasonic treatment apparatus and an arthroscopic apparatus in theactual use of the treatment system shown in FIG. 1.

FIG. 6 is a side view of a handpiece of a treatment system according tothe second embodiment.

FIG. 7 is a cross-sectional view of an enlarged portion B of FIG. 6.

FIG. 8 is a cross-sectional view taken along line F8-F8 in FIG. 6.

FIG. 9 is a cross-sectional view of a handpiece taken along a plane in alongitudinal axis C of the treatment system according to a thirdembodiment.

FIG. 10 illustrates the handpiece viewed from an arrow E shown in FIG.9.

DETAILED DESCRIPTION First Embodiment

The first embodiment of the present invention will be explained withreference to FIG. 1 to FIG. 5. The treatment system is used forarthroscopic surgery performed for a target region such as a joint of ashoulder, knee, elbow, etc. Specifically, as shown in FIG. 1, atreatment system 11 is used for treatment within a joint, namely,between a first bone 12 and a second bone 13. The treatment system 11includes an arthroscopic apparatus 14, an ultrasonic treatment apparatus15 (ultrasonic treatment assembly), and a perfusion apparatus 16. Anarthroscope 18 of the arthroscopic apparatus 14 is inserted into thejoint cavity 17 through a first cannula 37 a, and a sheath 51 and aprobe 44 (described later) of the ultrasonic treatment apparatus 15 areinserted into a joint cavity 17 through a second cannula 37 b.

The arthroscopic apparatus 14 is provided with the arthroscope 18 whichmonitors an inside of a joint of a patient, namely, the joint cavity 17,an image processing unit 26 that performs image processing based on asubject image captured by the arthroscope 18, and a monitor 22 thatdisplays an image generated by the image processing at the imageprocessing unit 26.

The arthroscope 18 includes an insertion section 23 and a holdingsection 24. In a treatment using the arthroscope 18, a distal endportion of the insertion section 23 is inserted into a joint. One end ofa universal cord 25 is connected to the holding section 24. The otherend of the universal cord 25 is connected to the image processing unit26. The image processing unit 26 is electrically coupled to a monitor 22(display unit).

An imaging element is provided at a distal end portion of the insertionsection 23. The imaging element is electrically connected to the imageprocessing unit 26. An image captured by the imaging element issubjected to image processing at the image processing unit 26, and isdisplayed on the monitor 22. The arthroscope 18 is coupled to a lightsource unit (not shown in the drawings), and light emitted from thelight source unit is applied to a subject.

The perfusion apparatus 16 includes an inflatable liquid source 27 inwhich perfusate such as a saline solution is shared, a perfusion pumpunit 28, a liquid transfer tube 31, one end of which is connected to theliquid source 27, a drainage tube 32, and a suction bottle 33 connectedto one end of the drainage tube 32. The suction bottle 33 is connectedto a suction pump unit 34 attached to a wall of an operation room. Theperfusion pump unit 28 is capable of transferring perfusate from theliquid source 27 by means of a liquid transfer pump 35. The perfusionpump unit 28 is capable of switching suction and stopping suction ofperfusate within the joint cavity 17 relative to the suction bottle 33by opening or closing a pinch valve 36 used as a drainage valve.

The liquid transfer tube 31, which is a liquid transfer path, isconnected to the first cannula 37 a at the other end. The liquidtransfer tube 32 is connected to the first cannula 37 a at the otherend. Accordingly, it is possible to transfer perfusate into the jointcavity 17 or drain perfusate from the joint cavity 17 through the firstcannula 37 a. It may be possible to provide a portal to a patient withwhich perfusate can be transferred or drained.

As shown in FIGS. 1 and 2, the ultrasonic treatment apparatus 15 isprovided with a handpiece (ultrasonic treatment apparatus) 41, anultrasonic vibrator unit 40 attached to the handpiece 41, a power supplyunit 42, a cable 43 which connects the ultrasonic vibrator unit 40 andthe power supply unit 42. In the following description, it is assumedthat one of the directions in a longitudinal axis C of the probe 44(main body section 61) provided to the handpiece 41 is a distal enddirection C1, and another direction which is opposite to the distal enddirection C1 is a proximal end direction C2, as shown in FIG. 2.

As shown in FIG. 1, the power supply unit 42 is provided with an energycontroller 45, and an ultrasonic current supply unit 46 which iscontrolled by the energy controller 45 to supply power to a vibrationgenerator. The ultrasonic vibrator unit 40 has a vibration generator 48which generates ultrasonic vibration, inside of a vibrator case 40A.

As shown in. FIGS. 1 to 3, the handpiece (ultrasonic treatmentapparatus) 41 is provided with a housing 47 constituting an outer shell,the rod-like probe 44 connected to the vibration generator 48, thehollow (cylindrical) sheath 51 which covers the periphery of the probe44 to protect the probe 44, and an energy input button 52 (switch)provided to the housing 47. The energy input button 52 is not shown inFIGS. 2 and 3. The energy input button 52 may be provided as a footswitch separated from the handpiece 41.

The vibrator case 40A (piezoelectric element 53) is connected to one endof a cable 43. The other end of the cable 43 is connected to the powersupply unit 42. If a doctor operates the energy input button 52, theenergy controller 45 senses an input operation of the energy inputbutton 52. The energy controller 45 then controls the ultrasonic currentsupply unit 46 to supply power to the vibration generator 48. By thisoperation, ultrasonic vibration (ultrasonic energy) is transmitted tothe probe 44, and the ultrasonic vibration is transmitted through theprobe 44 to a bone (living tissue) which is a treatment target.Accordingly, excision or removal treatment, for example, can be appliedto a bone (living tissue).

The vibration generator 48 is provided with a plurality of piezoelectricelements (vibrators) 53 and a horn member 54. The piezoelectric elements53 generate ultrasonic vibration upon receipt of power supplied from thepower supply unit 42. The horn member 54 increases an amplitude of theultrasonic vibration generated at the piezoelectric elements 53 andtransmits the ultrasonic vibration to the probe 44. The ultrasonicvibration in the direction along the longitudinal axis C (the directionin which the probe 44 is shortened and extended) is, for example,transmitted to the horn member 54 and the probe 44 connected to the hornmember 54. A resin sealing member 56 that prevents liquid from enteringthe inside of the sheath 51 is provided at a position corresponding to anode position 55 (a node position closest to the distal end direction C1side) of the ultrasonic vibration traveling on the probe 44 as statedabove. The sealing member 56 has a ring-like shape, and supports theprobe 44 so that the probe 44 is positioned at the center of the sheath51.

As shown in FIGS. 2 to 4, the probe 44 is formed of a metallic materialhaving biocompatibility (for example, a titanium alloy, etc.) as arod-like shape. The probe 44 has a main body section 61 extending as arod-like shape, and a treatment section 61A (distal end direction C1side section) provided at the distal end direction C1 side of the mainbody section 61. The treatment section 61A is bent in a directiondifferent from the direction along the longitudinal axis C. Thetreatment section 61A has a bending portion 62 provided in a part closeto the distal end direction C1 of the main body section 61, and anexcision region 63 (claw portion) extending in a direction crossing thelongitudinal axis C from the part closer to the distal end direction C1side than the bending portion 62, and excises a bone by transmission ofultrasonic vibration. The treatment section 61A has a diameter smallerthan the other portions of the probe 44, and is easier to be broken thenthe other portions. In particular, for removal of a hard tissue such asbone, an amplitude of ultrasonic vibration is set to be relativelylarge, and a stress applied to the probe 44 is relatively large. Thetreatment section 61A receives a relatively large stress in the samemanner.

The main body section 61 is capable of transmitting ultrasonic vibrationreceived from the vibration generator 48 from the proximal end to thedistal end direction C1 side. The treatment section 61A is bent toprotrude in the direction crossing the longitudinal axis C of the mainbody section 61. The bending portion 62 (top portion) has a largestcurvature in the main body section 61 of the probe 44. While ultrasonicvibration is applied during treatment, the bending portion 62 is easilybroken in a case of coming into contact with the arthroscope 18.

The wavelength of ultrasonic vibration to be input to the probe 44 isdetermined based on a resonant frequency of the piezoelectric elements53 of the ultrasonic vibrator unit 40. That is, the length of the probe44 is determined based on the piezoelectric elements 53 to be used.Thus, the probe 44 has a length so that an anti-node position ofvibration is determined at the treatment section 61A when ultrasonicvibration is input to the proximal end of the probe 44 from thepiezoelectric elements 53 of the ultrasonic vibrator unit 40, and theultrasonic vibration is transmitted to the distal end direction C1 sidefrom the proximal end of the probe 44. The anti-node position ofvibration preferably matches the position of the excision region 63.That is, the position of the excision region 63 is adjusted tocorrespond to the anti-node position of vibration. When ultrasonicvibration is transmitted, a first node position of vibration at theproximal end side relative to the anti-node position of vibration isdefined between the proximal end and the distal end of the main bodysection 61 of the probe 44.

The sheath 51 includes a first portion 64 having a tubular shape such asa cylindrical shape, and a second portion 65 extending from the firstportion 64. The second portion 65 is provided at a side where theexcision region 63 is provided. As shown in FIG. 4, the second portion65 is provided to project from the first portion 64 and to havesubstantially half of the size of the cylinder corresponding to 180°around the longitudinal axis C, for example. The second portion 65extends from the first portion 64 to the position to cover a portioncorresponding to the bending portion 62 of the probe 44. The distal endof the second portion 65 extends in the distal end direction C1 over thebending portion 62 in comparison with the distal end of the firstportion 64. On the other hand, the second portion 65 is not provided tothe side opposite at the side where the excision region 63 is defined,and the probe 44 is externally exposed at this position. Accordingly,the side opposite to the side corresponding to the second portion 65 ofthe proximal end portion of the treatment section 61A of the probe 44 isdefined as an exposed portion 66.

Next, a surgical method using the treatment system 11 according to thepresent embodiment will be described with reference to FIG. 5. Theultrasonic treatment apparatus 15 of the treatment system 11 accordingto the present embodiment is used within the joint cavity 17, forexample, and is capable of resecting and removing a tissue to be removed(removal target) by bringing the probe 44 to which ultrasonic vibrationis transmitted into contact with a removal target such as a bone spur.

First, the joint cavity 17 is filled with perfusate by a well-knownmethod. A suitable portal that reaches into the joint cavity 17 from theoutside is used to insert the arthroscope 18 into the joint cavity 17 tocheck the state of a patient. A doctor uses another portal to insert theprobe 44 and the sheath 51 of the handpiece 41 into the joint cavity 17.A plurality of well-known portals which are access paths to the insideof a joint are present in each joint.

When inserting the probe 44 into the joint cavity 17, the probe 44 towhich ultrasonic vibration is transmitted can be used for removal ofintervening soft tissue such as a synovial membrane, synovial bursa,cartilage, etc. Accordingly, when inserting the probe 44 and the sheath51 into the joint cavity 17, there is no need to switch treatment tools,thereby improving workability.

As shown in FIG. 5, there is a case where a doctor places the probe 44and the arthroscope 18 so that the distal end portion of the insertionsection 23 of the arthroscope 18 is placed close to the excision region63 side of the probe 44. The doctor can transmit ultrasonic vibration tothe probe 44 when pressing the energy input button 52 while the excisionregion 63 of the probe 44 is brought into contact with a bone spur, etc.of the bone 12 (living tissue) to be treated under the operation of thearthroscope 18. By this process, removal or excision of a hard tissue tobe treated such as a bone can be accomplished. At this time, it islikely that the insertion section 23 of the arthroscope 18 is placedclose to the probe 44 as shown in FIG. 5. In such a case, the excisionregion 63 side of the probe 44 is protected by the second portion 65extending relative to the first portion 64 of the sheath 51.Accordingly, the ultrasonically vibrating probe 44 is prevented fromcoming into contact with the insertion section 23 of the arthroscope 18.Thus, in the case where the insertion section 23 of the arthroscope 18is located near the excision region 63 of the probe 44, the insertionsection 23 of the arthroscope 18 is placed close to or in contact withthe sheath 51, to be prevented from coming in contact with the probe 44,thereby preventing the probe 44 from being broken (or damaging thearthroscope 18) at the treatment section 61A, for example.

According to the first embodiment, the ultrasonic treatment apparatus 15used for surgery using the arthroscope 18 comprises; the probe 44including the main body section 61 to which ultrasonic vibration istransmitted, the excision region 63 which is provided at the distal endside of the main body section 61 and excises a bone by the ultrasonicvibration, the sheath 51 including the first portion 64 that covers themain body section 61 of the probe 44, and the second portion 65, whichextends from the first portion 64 to cover the side where the excisionregion 63 of the main body section 61 is provided.

With this configuration, the second portion 65 is provided to cover theside where the excision region 63 of the probe 44 is provided, therebypreventing a problem that the probe 44 to which ultrasonic vibration istransmitted is in contact with the arthroscope 18.

The main body section 61 has the bending portion 62 that is bentrelative to the longitudinal axis C of the main body section 61, and thesecond portion 65 of the sheath 51 covers the side of the bendingportion 62 where the excision region 63 is defined. With thisconfiguration, the portion corresponding to the bending portion 62 ofthe probe 44 which has the largest curvature and is easiest to be brokencan be protected by the second portion 65. Accordingly, even if a doctorunintentionally brings the probe 44 close to the arthroscope 18 duringsurgery, the arthroscope 18 is not brought into contact with the portioncorresponding to the bending portion 62 of the probe 44.

Thus, the probe 44 can be prevented from being broken at a positionwhere the bending portion 62 is provided. In addition, the secondportion 65 has a shape of Substantially half of the cylinder which canbe simply accomplished. Therefore, even if the second portion 65 isprovided, an increase in the manufacturing costs can be suppressed.

Second Embodiment

A treatment system 11 according to the second embodiment will bedescribed with reference to FIGS. 6 to 8. The treatment system 11 of thesecond embodiment is different from the treatment system 11 of the firstembodiment in that a second sheath 76 and a suction path 71 are providedinside of a sheath 51 of an ultrasonic treatment apparatus 15, but theother structures are identical to those of the first embodiment.Accordingly, mainly portions different from the first embodiment will beexplained, and portions the same as the first embodiment will not beexplained or shown in the drawings.

As shown in FIGS. 6 to 8, a handpiece 41 of the ultrasonic treatmentapparatus 15 includes a rod-like probe 44, a hollow (a tubular shapesuch as a cylindrical shape) sheath 51 which covers the periphery of theprobe 44 to protect the probe 44, a second sheath 76 (tubular member)which is a tubular shape such as a cylindrical shape and provided insideof the sheath 51, a suction path 71 provided between the sheath 51 andthe second sheath 76, a connection cap 72 connected to the suction path71, and an energy input button 52 (switch) provided to a housing 47.

As shown in FIG. 6, the ultrasonic treatment apparatus 15 is alsoprovided with a suction source 73 which includes a vacuum pump, etc, andcauses negative pressure in the suction path, and with a tank 74 tostore suctioned liquid or living tissue between the suction path 71 andthe suction source 73. The suction path 71 is connected to the suctionsource 73 through the connection cap 72 and a tube 75 connected thereto.

As shown in FIGS. 6 and 7, the second sheath 76 (tubular member), whichis an inner sheath, is interposed between the first portion 64 of thesheath 51, which is an outer sheath, and the probe 44. The second sheath76 is provided to cover the probe 44 (main body section 61). In theembodiment, the second sheath 76 is arranged to be eccentric relative toa central axis D of the sheath 51. Thus, a central axis C of the secondsheath 76 is shifted relative to the central axis D of the sheath 51. Asshown in FIG. 8, the second sheath 76 includes a proximal part 76A closeto a part 51A on an inner peripheral surface of the sheath 51, and adistal part 76B opposite to the proximal part 76A.

As shown in FIGS. 7 and 8, the suction path 71 is provided in a spacebetween the inner side of the first portion 64 of the sheath 51 and theouter side of the second sheath 76. Specifically, the suction path 71 isprovided between the distal part 76B and the inner peripheral surface ofthe sheath 51 (positioned away from the part 51A of the inner peripheralsurface of the sheath 51). The suction path 71 includes a suctionopening 71A exposed to the outside at the distal end direction C1 side.

A surgical method using the treatment system 11 according to the presentembodiment will be described with reference to FIGS. 6 to 8.

A joint cavity 17 is filled with perfusate by a well-known method. Anarthroscope 18 is inserted into the joint cavity 17 from a suitableportal to check the condition of a patient. A doctor uses another portalto insert the probe 44 and the sheath 51 of the handpiece 41 into thejoint cavity 17. When inserting the probe 44 into the joint cavity 17,the probe 44 to which ultrasonic vibration is transmitted can be usedfor removal of an intervening soft tissue such as a synovial membrane,synovial bursa, cartilage, etc., similar to the first embodiment.

As shown in FIG. 5, a doctor places the probe 44 and the arthroscope 18so that the distal end portion of the arthroscope 18 is placed near thesheath 51 at the excision region 63 side of the probe 44. The doctor cantransmit ultrasonic vibration to the probe 44 when pressing the energyinput button 52 while the excision region 63 of the probe 44 is broughtinto contact with a bone spur, etc. of the bone 12 (living tissue) to betreated under the operation of the arthroscope 18. By this process,removal or excision of a hard tissue to be treated, such as a bone canbe accomplished. In this case, the excision region 63 side of the probe44 (portion corresponding to a bending portion 62) is protected by asecond portion 65 of the sheath 51. Accordingly, the probe 44 isprevented from being broken by coming in contact with the arthroscope 18while ultrasonic vibration is transmitted to the probe 44.

According to the present embodiment, in the state where the ultrasonictreatment apparatus 15 of the treatment system 11 is powered on, thesuction source 73 is in continuous operation, and a fragment of a livingtissue or an air bubble generated at the excision region 63 can besuctioned and removed through the suction source 73. In addition,according to the present embodiment, since the second sheath 76 isprovided to be eccentric relative to the central axis D of the sheath51, the diameter of the suction path 71 and the suction opening 71A isensured to be relatively large. Thus, it is possible to suction afragment of a bone which is relatively large through the suction opening71A and the suction path 71.

According to the present embodiment, a tubular member provided to coverthe probe 44 between the first portion 64 of the sheath 51 and the probe44, and the suction path 71 provided in a space between the firstportion 64 and the tubular member and connected to the suction source 73are provided.

With this configuration, a fragment of a living tissue or an air bubblegenerated by treatment can be removed through the suction path 71,thereby ensuring a clear view under an arthroscope. In particular, afragment can be suctioned and removed near a place where the fragment isgenerated (the excision region 63 of the probe 44), thereby removing thefragment before being diffused to the periphery. Accordingly, it ispossible to remove a fragment efficiently and to reliably provide aclear view under an arthroscope while preventing cloudiness of theperfustate. Small fragments such as powdered fragments rise to obstructa field of view of the arthroscope 18. Accordingly, it is extremelyefficient to remove such fragments near the excision region 63 in orderto perform surgery effectively and safely.

The tubular member includes the proximal part 76A provided to beeccentric relative to the central axis D of the sheath 51 and close tothe part 51A on an inner peripheral surface of the sheath 51, and thedistal part 76B opposite to the proximal part 76A, and the suction path71 is provided between the distal part 76B and a position away from thepart 51A on an inner peripheral surface of the sheath 51.

With this configuration, the diameter of the suction path 71 is ensuredto be large in comparison with the case where the tubular member isprovided so that the central axis C of the tubular member matches thecentral axis D of the sheath 51. Accordingly, it is possible to suctionand remove not only small powdered fragments, but also a fragment havinga relatively large diameter, thereby improving fragment removalefficiency. Therefore, it is possible to ensure a clear view under thearthroscope 18 and to promote safety of surgery.

Third Embodiment

A treatment system according to the third embodiment will be describedwith reference to FIGS. 9 and 10. The treatment system 11 of the thirdembodiment is different from the treatment system 11 of the secondembodiment in that a second portion 65 of a sheath 51 of an ultrasonictreatment apparatus 15 has a notch 81, but the other structures areidentical to those of the second embodiment. Accordingly, mainlyportions different from the second embodiment will be explained, andportions the same as the second embodiment will not be explained orshown in the drawings.

As shown in FIGS. 9 and 10, the sheath 51 includes a first portion 64having a tubular shape such as a cylindrical shape, and a second portion65 extending from the first portion 64. The second portion 65 isprovided at a side where an excision region 63 is provided. For example,the second portion 65 is provided to correspond to an angle of 180°around the longitudinal axis C. The second portion 65 has a notch 81which is a slit-like portion extending toward the proximal end directionC2 from the distal end of the second portion 65. The notch 81 includes amain body part 81A extending linearly along the longitudinal axis C, andan arch-shaped bottom part 81B provided at an end of the proximal enddirection C2 side of the main body part 81A. The length of the notch 81along the longitudinal axis C is substantially the same as the length ofthe second portion 65 along the longitudinal axis C.

The notch 81 may be provided to span across the second portion 65 andthe first portion 64, not only in the second portion 65. In this case,it is preferable that the notch 81 extends from the distal end portionof the second portion 65 to the proximal end direction C2 side, and thebottom part 81B of the notch 81 is located closer to the distal enddirection C1 side than a node position 55 (a node position closest tothe distal end direction C1 side) of ultrasonic vibration transmitted tothe probe 44.

The width in the direction crossing the longitudinal axis C of the notch81 is set to be smaller than the diameter of an arthroscope 18 to beused. More specifically, a diameter D1 of the arthroscope 18 is set tobe within the range of 2<D1<10 (mm), for example, while a size D2 of thenotch 81 is set to be within the range of 1≤D2≤10 mm), for example.

A surgical method using the treatment system 11 according to the presentembodiment will be described with reference to FIGS. 9 and 10.

A joint cavity 17 is filled with perfusate by a well-known method. Thearthroscope 18 is inserted into the joint cavity 17 from a suitableportal to check the condition of a patient. A doctor uses another portalto insert the probe 44 and the sheath 51 of the handpiece 41 into thejoint cavity 17. When inserting the probe 44 into the joint cavity 17,the probe 44 to which ultrasonic vibration is transmitted can be usedfor removal of intervening soft tissue such as a synovial membrane,synovial bursa, cartilage, etc., similar to the other embodiments.

As shown in FIG. 5, a doctor places the probe 44 and the arthroscope 18so that the distal end portion of the arthroscope 18 is placed near thesheath 51 at the excision region 63 side of the probe 44. The doctor cantransmit ultrasonic vibration to the probe 44 when pressing an energyinput button 52 while the excision region 63 of the probe 44 is broughtinto contact with a bone spur, etc. of the bone 12 (living tissue) to betreated under the operation of the arthroscope 18. By this process,removal or excision of a hard tissue to be treated such as a bone can beaccomplished. In this case, the excision region 63 side of the probe 44is protected by the second portion 65 of the sheath 51. Accordingly, theprobe 44 is prevented from being broken by coming in contact with thearthroscope 18 while ultrasonic vibration is transmitted to the probe44.

In the present embodiment, the slit-like notch 81 is provided to thesecond portion 65. Accordingly, even if an operation is performed underthe condition shown in FIG. 5, the probe 44 and the excision region 63can be visually recognized through the notch 81 under the arthroscope18. Accordingly, the present embodiment realizes further improvement ofefficiency and safety in the surgery.

Furthermore, according to the present embodiment, in the state where theultrasonic treatment apparatus 15 of the treatment system 11 is poweredon, a suction source 73 is perpetually actuated, and a fragment of aliving tissue or an air bubble generated at the excision region 63 canbe suctioned and removed through the suction source 73. In addition,according to the present embodiment, since a second sheath 76 isprovided to be eccentric relative to the central axis D of the sheath51, the diameter of a suction path 71 and a suction opening 71A isensured to be large so that a large fragment can be suctioned, similarto the second embodiment.

According to the present embodiment, the second portion 65 has the notch81 which extends toward the proximal end direction C2 side which isopposite to the distal end direction C1 side of a main body section 61.With this configuration, when the arthroscope 18 is used at the excisionregion 63 side of the probe 44 for operation, the probe 44 and theexcision region 63 are not hidden by the second portion 65 forprotecting the probe 44, and the visual recognition of the probe 44 andthe excision region 63 can be improved. Accordingly, a doctor canperform surgery efficiently and safely.

Furthermore, the width of the notch 81 in the direction crossing thelongitudinal axis C of the notch 61 is set to be smaller than thediameter of the arthroscope 18 to be used in the arthroscopic surgery.With this configuration, the arthroscope 18 is not erroneously insertedinto the notch 81 even if the notch 81 is provided to the second portion65. Thus, a problem of the arthroscope 18 and the probe 44 coming incontact with each other due to the notch 81 can be prevented.

The present invention is not limited to the above-described embodiments,and can be modified in various manners when reduced to practice, withoutdeparting from the gist of the invention. In addition, the treatmentsystem 11 according to each embodiment can of course be combined tofunction as a treatment system.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details and representative embodiments shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

What is claimed is:
 1. An ultrasonic treatment apparatus for use inarthroscopic surgery, comprising: a probe including a main body sectionto which ultrasonic vibration is transmitted, and a treatment sectionprovided in a distal end side of the main body section and including anexcision region that excises a bone by the ultrasonic vibration; and asheath including a first portion provided to cover the main body sectionof the probe, and a second portion extending from the first portion tocover a part of the treatment section, at a side where the excisionregion is provided, closer to a proximal end side than the excisionregion, wherein a notch extending toward the proximal end side which isopposite to the distal end side of the main body section is provided tothe second portion.
 2. The ultrasonic treatment apparatus according toclaim 1, wherein: the treatment section includes a bending portion thatis bent relative to a longitudinal direction of the main body section,and the second portion of the sheath covers a side of the bendingportion where the excision region is provided.
 3. The ultrasonictreatment apparatus according to claim 1, wherein a width of the notchin a direction crossing a longitudinal direction of the main bodysection is set to be between 1 to 2 mm.
 4. The ultrasonic treatmentapparatus according to claim 1, comprising: a tubular member provided tocover the in body section of the probe between the first portion of thesheath and the probe; and a suction path provided between the firstportion of the sheath and the tubular member and connected to a suctionsource.
 5. The ultrasonic treatment apparatus according to claim 4,wherein: the tubular member includes a proximal part provided to beeccentric to a central axis of the sheath and close to a part on aninner peripheral surface of the sheath, and a distal portion provided ata side opposite to the proximal part, and the suction path is providedbetween the distal part and a position away from the part of the innerperipheral surface of the sheath.
 6. An ultrasonic treatment assemblycomprising: the ultrasonic treatment apparatus according to 1; and anultrasonic vibrator unit detachably attached to the ultrasonic treatmentapparatus.